Medical monitoring analysis and replay including indicia responsive to light attenuated by body tissue

ABSTRACT

The present disclosure includes a medical monitoring hub as the center of monitoring for a monitored patient. The hub is configured to receive and process a plurality of physiological parameters associated with the patient. The hub includes advanced analytical presentation views configured to provide timely, clinically-relevant, actionable information to care providers. In certain embodiments, the monitoring hub stores and is able to replay previously presented data reflective of the patient&#39;s condition.

INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS

The present application is a continuation of U.S. patent applicationSer. No. 15/233,244, filed Aug. 10, 2016, entitled “MEDICAL MONITORINGANALYSIS AND REPLAY INCLUDING INDICIA RESPONSIVE TO LIGHT ATTENUATED BYBODY TISSUE,” now U.S. Pat. No. 10,991,135, which claims prioritybenefit under 35 U.S.C. § 119(e) to U.S. Provisional Application No.62/203,792, filed Aug. 11, 2015, which is hereby incorporated byreference in its entirety herein. Any and all applications for which aforeign or domestic priority claim is identified in the Application DataSheet as filed with the present application are hereby incorporated byreference under 37 CFR 1.57.

FIELD

The present disclosure relates generally to a patient monitor andmedical data communication hub and specifically to a patient monitorincluding display elements for presenting measurement information, oftenover a time period, to a caregiver.

BACKGROUND

Today's patient monitoring environments are crowded with sophisticatedand often electronic medical devices servicing a wide variety ofmonitoring and treatment endeavors for a given patient. Generally, manyif not all of the devices are from differing manufactures, and many maybe portable devices. The devices may not communicate with one anotherand each may include its own control, display, alarms, configurationsand the like. Complicating matters, caregivers often desire to associateall types of measurement and data from these devices with a specificpatient. Patient information entry often occurs at each device.Sometimes, the disparity in devices leads to a need to simply print andstore paper from each device in a patient's file for caregiver review.

Thus, while the electronic collection of physiological data associatedwith the patient's condition has increased, the ability to synthesizethe collected patient data into timely, clinically-relevant, actionableinformation remains a challenge.

SUMMARY

Based on at least the foregoing, a solution is needed that coordinatesthe various medical devices treating or monitoring a patient and themeasurement data being generated by such devices. Embodiments of such asolution may include a medical hub that presents, via graphical display,a variety of analytical presentation views that deliver to the caregivereasily-seen, intuitive, visual indications of the status and conditionof the patient being monitored. In an embodiment, the analyticalgraphical views may advantageously be replayed for analysis of criticalevents in the patient's care, or to simply review the patient'sphysiological activity over a period of time. In an embodiment, thereplays of several physiological parameters may be played synchronously,providing a broad perspective of the patient's historical activity.

According to an embodiment of the present disclosure, a medicalmonitoring hub is configured to monitor physiological parameters of apatient. The hub includes a first communication port configured toreceive a first signal indicative a first physiological parameterassociated with the patient. The monitor also includes a displayconfigured to present analytical presentation views to the user. Themonitor includes at least one processor configured to process thereceived first signal and to cause a first view to be presented on atleast a portion of the display. The first view is adapted to presentfirst data indicative of the first physiological parameter collectedover a first period of time. The hub includes a storage deviceconfigured to store the presented first data, and the processor isfurther configured to replay the stored first data on the display.

In certain embodiments of the present disclosure, various analyticalpresentation views are disclosed to help clinicians easily andintuitively interpret the patient data that is received by themonitoring hub. Heat maps are disclosed which provide a two-dimensionalgraphical representation of a relationship between two measuredphysiological parameters over a specified period of time.Advantageously, heat maps use color to identify areas in the graph wherethe data is concentrated. For example, areas where the data is highlyconcentrated can be presented in a first color (e.g., red), while areasin which the data is less highly concentrated can be presented in asecond color (e.g., blue).

Also disclosed are box-and-whisker plots which visually present therange of physiological parameter measurements received over a specifiedor pre-determined period of time. Additionally, the boundaries of thequartiles in which the data lies are presented by the box-and-whiskerplots. Advantageously, the box-and-whisker plot readily presents to theuser the degree of spread, or dispersion of the measured data, as wellas the skewness in the data, including outlier measurements.

Index box views are disclosed as well. An index box view presents acurrent measured state of a physiological parameter relative to rangesidentified as, for example, acceptable, cautionary, and emergent, usingcolors and other visual cues to readily indicate the measured state ofthe patient.

The present disclosure also describes distribution analyticalpresentation views which present a statistical distribution (e.g., aGaussian distribution) of physiological parameter measurements over aspecified or pre-defined period of time. Similarly, the presentdisclosure describes histogram analytical presentation views whichprovide yet another graphical representation of a measured physiologicalparameter data. A histogram represents an estimate of the statistical(or probability) distribution of a continuous variable, such as acontinuously measured physiological parameter. Thus, rather thanproviding a statistical distribution (i.e., a probabilistic model) thatbest fits or corresponds to the measured data, the histogram reflectsthe actual measured data collected.

The present disclosure also includes gauge-histogram analyticalpresentation views, which provide a combination of analog, digital, andhistogram display indicia. Advantageously, the gauge-histogramanalytical presentation view provides to the clinician a substantialamount of information related to the measured physiological parameter inan intuitive and visually accessible format.

In use, the clinician is provided a great deal of flexibility inarranging and configuring the disclosed analytical presentation views ofthe present disclosure. Thus, the clinician is provided a monitoringenvironment that can be customized to the clinician's and/or patient'sspecific needs.

For purposes of summarizing the disclosure, certain aspects, advantagesand novel features are discussed herein. It is to be understood that notnecessarily all such aspects, advantages or features will be embodied inany particular embodiment of the invention, and an artisan wouldrecognize from the disclosure herein a myriad of combinations of suchaspects, advantages or features.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments will be described hereinafter with reference to theaccompanying drawings. The drawings and the associated descriptions areprovided to illustrate embodiments of the present disclosure and do notlimit the scope of the claims. In the drawings, similar elements havesimilar reference numerals.

FIGS. 1A-1C illustrate perspective views of an exemplary medicalmonitoring hub according to an embodiment of the disclosure. Forexample, FIG. 1A illustrates the hub with an exemplary docked portablepatient monitor; FIG. 1B illustrates the hub with a set of medical portsand a noninvasive blood pressure input; and FIG. 1C illustrates the hubwith various exemplary temperature sensors attached thereto, allaccording to various embodiments of the disclosure.

FIG. 2 illustrates a simplified block diagram of an exemplary monitoringenvironment including the hub of FIG. 1 , according to an embodiment ofthe disclosure.

FIG. 3 illustrates a simplified exemplary hardware block diagram of thehub of FIG. 1 , according to an embodiment of the disclosure.

FIG. 4 is a finger control gesture legend for a touchscreen interfaceaccording to an embodiment of the disclosure.

FIG. 5 is an illustration of a display view according to an embodimentof the disclosure.

FIG. 6A illustrates an exemplary display screen showing variousanalytical presentation views for presenting received and processed dataaccording to an embodiment of the disclosure.

FIG. 6B illustrates a heat map analytical presentation view according toan embodiment of the disclosure.

FIG. 6C illustrates a box-and-whisker analytical presentation viewaccording to an embodiment of the disclosure.

FIG. 6D illustrates an index analytical presentation view according toan embodiment of the disclosure.

FIG. 6E illustrates a distribution analytical presentation viewaccording to an embodiment of the disclosure.

FIG. 6F illustrates a histogram analytical presentation view accordingto an embodiment of the disclosure.

FIG. 6G illustrates a gauge-histogram analytical presentation viewaccording to an embodiment of the disclosure.

FIG. 7 illustrates an exemplary display screen showing a replay featureaccording to an embodiment of the disclosure.

FIG. 8 is a flowchart illustrating a replay process according to anembodiment of the disclosure.

While the foregoing “Brief Description of the Drawings” referencesgenerally various embodiments of the disclosure, an artisan willrecognize from the disclosure herein that such embodiments are notmutually exclusive. Rather, the artisan would recognize a myriad ofcombinations of some or all of such embodiments.

DETAILED DESCRIPTION

The present disclosure relates to a medical monitoring hub configured tobe the center of monitoring activity for a given patient. In anembodiment, the hub comprises a large easily readable display, such asan about ten (10) inch display dominating the majority of real estate ona front face of the hub. The display could be much larger or muchsmaller depending upon design constraints. However, for portability andcurrent design goals, the preferred display is roughly sizedproportional to the vertical footprint of one of a dockable portablepatient monitor. Other considerations are recognizable from thedisclosure herein by those in the art.

Configurable Replay Display

In an embodiment, the display is configurable by dragging and droppinggestures to populate the display with elements a caregiver prefers toview for a particular user. The elements may include some or all of aheat map, a box-and-whisker plot, a distribution plot, a histogram, ananalog gage, and an analog gage combined with a histogram. Onceconfigured, the hub processor may allow for the replay of selectedmeasurement data, data responsive to the measurement data, orcombinations of measurement data over a selected or default time periodat a selected or default display rate. Advantageously, suchconfiguration and replay provide a powerful tool for a caregiver toreview the patient's condition over virtually any period of timedesired.

Monitoring Hub

The display provides measurement data for a wide variety of monitoredparameters for the patient under observation in numerical or graphicform, and in various embodiments, is automatically configured based onthe type of data and information being received at the hub. In anembodiment, the hub is moveable, portable, and mountable so that it canbe positioned to convenient areas within a caregiver environment. Forexample, the hub is collected within a singular housing.

In an embodiment, the hub may advantageously receive data from aportable patient monitor while docked or undocked from the hub. Typicalportable patient monitors, such as oximeters or co-oximeters can providemeasurement data for a large number of physiological parameters derivedfrom signals output from optical and/or acoustic sensors, electrodes, orthe like. The physiological parameters include, but not limited tooxygen saturation, carboxy hemoglobin, methemoglobin, total hemoglobin,glucose, pH, bilirubin, fractional saturation, pulse rate, respirationrate, components of a respiration cycle, indications of perfusionincluding perfusion index, signal quality and/or confidences,plethysmograph data, indications of wellness or wellness indexes orother combinations of measurement data, audio information responsive torespiration, ailment identification or diagnosis, blood pressure,patient and/or measurement site temperature, depth of sedation, organ orbrain oxygenation, hydration, measurements responsive to metabolism,combinations of the same or the like, to name a few. In otherembodiments, the hub may output data sufficient to accomplishclosed-loop drug administration in combination with infusion pumps orthe like.

In an embodiment, the hub communicates with other devices in amonitoring environment that are interacting with the patient in a numberof ways. For example, the hub advantageously receives serial data fromother devices without necessitating their reprogramming or that of thehub. Such other devices include pumps, ventilators, all manner ofmonitors monitoring any combination of the foregoing parameters,ECG/EEG/EKG devices, electronic patient beds, and the like. Moreover,the hub advantageously receives channel data from other medical deviceswithout necessitating their reprogramming or that of the hub. When adevice communicates through channel data, the hub may advantageouslyalter the large display to include measurement information from thatdevice. Additionally, the hub accesses nurse call systems to ensure thatnurse call situations from the device are passed to the appropriatenurse call system.

The hub also communicates with hospital systems to advantageouslyassociate incoming patient measurement and treatment data with thepatient being monitored. For example, the hub may communicate wirelesslyor otherwise to a multi-patient monitoring system, such as a server orcollection of servers, which in turn many communicate with a caregiver'sdata management systems, such as, for example, an Admit, Discharge,Transfer (“ADT”) system and/or an Electronic Medical Records (“EMR”)system. The hub advantageously associates the data flowing through itwith the patient being monitored thereby providing the electronicmeasurement and treatment information to be passed to the caregiver'sdata management systems without the caregiver associating each device inthe environment with the patient.

In an embodiment, the hub advantageously includes a reconfigurable andremovable docking station. The docking station may dock additionallayered docking stations to adapt to different patient monitoringdevices. Additionally, the docking station itself is modularized so thatit may be removed if the primary dockable portable patient monitorchanges its form factor. Thus, the hub is flexible in how its dockingstation is configured.

In an embodiment, the hub includes a large memory for storing some orall of the data it receives, processes, and/or associates with thepatient, and/or communications it has with other devices and systems.Some or all of the memory may advantageously comprise removable SDmemory.

The hub communicates with other devices through at least (1) the dockingstation to acquire data from a portable monitor, (2) innovativeuniversal medical connectors to acquire channel data, (3) serial dataconnectors, such as RJ ports to acquire output data, (4) Ethernet, USB,and nurse call ports, (5) Wireless devices to acquire data from aportable monitor, (6) other wired or wireless communication mechanismsknown to an artisan. The universal medical connectors advantageouslyprovide optional electrically isolated power and communications, aredesigned to be smaller in cross section than isolation requirements. Theconnectors and the hub communicate to advantageously translate orconfigure data from other devices to be usable and displayable for thehub. In an embodiment, a software developers kit (“SDK”) is provided toa device manufacturer to establish or define the behavior and meaning ofthe data output from their device. When the output is defined, thedefinition is programmed into a memory residing in the cable side of theuniversal medical connector and supplied as an original equipmentmanufacturer (“OEM”) to the device provider. When the cable is connectedbetween the device and the hub, the hub understands the data and can useit for display and processing purposes without necessitating softwareupgrades to the device or the hub. In an embodiment, the hub cannegotiate the schema and even add additional compression and/orencryption. Through the use of the universal medical connectors, the huborganizes the measurement and treatment data into a single display andalarm system effectively and efficiently bringing order to themonitoring environment.

As the hub receives and tracks data from other devices according to achannel paradigm, the hub may advantageously provide processing tocreate virtual channels of patient measurement or treatment data. In anembodiment, a virtual channel may comprise a non-measured parameter thatis, for example, the result of processing data from various measured orother parameters. An example of such a parameter includes a wellnessindicator derived from various measured parameters that give an overallindication of the wellbeing of the monitored patient. An example of awellness parameter is disclosed in U.S. patent application Ser. Nos.13/269,296, 13/371,767 and 12/904,925, by the assignee of the presentdisclosure and incorporated by reference herein. By organizing data intochannels and virtual channels, the hub may advantageously time-wisesynchronize incoming data and virtual channel data.

The hub also receives serial data through serial communication ports,such as RJ connectors. The serial data is associated with the monitoredpatient and passed on to the multi-patient server systems and/orcaregiver backend systems discussed above. Through receiving the serialdata, the caregiver advantageously associates devices in the caregiverenvironment, often from varied manufactures, with a particular patient,avoiding a need to have each individual device associated with thepatient and possible communicating with hospital systems. Suchassociation is vital as it reduces caregiver time spent enteringbiographic and demographic information into each device about thepatient. Moreover, in an embodiment, through the SDK the devicemanufacturer may advantageously provide information associated with anymeasurement delay of their device, thereby further allowing the hub toadvantageously time-wise synchronize serial incoming data and other dataassociated with the patient.

In an embodiment, when a portable patient monitor is docked, and itincludes its own display, the hub effectively increases its display realestate. For example, in an embodiment, the portable patient monitor maysimply continue to display its measurement and/or treatment data, whichmay be now duplicated on the hub display, or the docked display, mayalter its display to provide additional information. In an embodiment,the docked display, when docked, presents anatomical graphical data of,for example, the heart, lungs, organs, the brain, or other body partsbeing measured and/or treated. The graphical data may advantageouslyanimate similar to and in concert with the measurement data. Forexample, lungs may inflate in approximate correlation to the measuredrespiration rate and/or the determined inspiration/expiration portionsof a respiration cycle, the heart may beat according to the pulse rate,may beat generally along understood actual heart contraction patterns,the brain may change color or activity based on varying depths ofsedation, or the like. In an embodiment, when the measured parametersindicate a need to alert a caregiver, a changing severity in color maybe associated with one or more displayed graphics, such as the heart,lungs, brain, organs, circulatory system or portions thereof,respiratory system or portions thereof, other body parts or the like. Instill other embodiments, the body portions may include animations onwhere, when or how to attach measurement devices.

The hub may also advantageously overlap parameter displays to provideadditional visual information to the caregiver. Such overlapping may beuser definable and configurable. The display may also incorporateanalog-appearing icons or graphical indicia.

In the interest of clarity, not all features of an actual implementationare described in this specification. An artisan will of course beappreciate that in the development of any such actual implementation (asin any development project), numerous implementation-specific decisionsmust be made to achieve a developers' specific goals and sub-goals, suchas compliance with system- and business-related constraints, which willvary from one implementation to another. Moreover, it will beappreciated that such a development effort might be complex andtime-consuming, but would nevertheless be a routine undertaking ofdevice engineering for those of ordinary skill having the benefit ofthis disclosure.

To facilitate a complete understanding of the disclosure, the remainderof the detailed description describes the disclosure with reference tothe drawings, wherein like reference numbers are referenced with likenumerals throughout.

Embodiments of Monitoring Hub

FIG. 1A illustrates a perspective view of an exemplary medicalmonitoring hub 100, which may also be referred to herein as a monitor100, with an exemplary docked portable patient monitor 102 according toan embodiment of the disclosure. The hub 100 includes a display 104, anda docking station 106, which in an embodiment is configured tomechanically and electrically mate with the portable patient monitor102, each housed in a movable, mountable and portable housing 108. Thehousing 108 includes a generally upright inclined shape configured torest on a horizontal flat surface, although the housing 108 can beaffixed in a wide variety of positions and mountings and comprise a widevariety of shapes and sizes.

In an embodiment, the display 104 may present a wide variety ofmeasurement and/or treatment data in numerical, graphical, waveform, orother display indicia 110. In an embodiment, the display 104 occupiesmuch of a front face of the housing 108, although an artisan willappreciate the display 104 may comprise a tablet or tabletop horizontalconfiguration, a laptop-like configuration or the like. Otherembodiments may include communicating display information and data to atable computer, smartphone, television, or any display systemrecognizable to an artisan. The upright inclined configuration of FIG.1A presents display information to a caregiver in an easily viewablemanner.

FIG. 1B shows a perspective side view of an embodiment of the hub 100including the housing 108, the display 104, and the docking station 106without a portable monitor docked. Also shown is a connector fornoninvasive blood pressure 113.

In an embodiment, the housing 108 may also include pockets orindentations to hold additional medical devices, such as, for example, ablood pressure monitor or temperature sensor 112, such as that shown inFIG. 1C.

The monitor 102 may communicate with a variety of noninvasive and/orminimally invasive devices such as optical sensors with light emissionand detection circuitry, acoustic sensors, devices that measure bloodparameters from a finger prick, cuffs, ventilators, and the like. Themonitor 102 may include its own display 114 presenting its own displayindicia 116, discussed below with reference to FIGS. 19A-19J. Thedisplay indicia may advantageously change based on a docking state ofthe monitor 102. When undocked, the display indicia may includeparameter information and may alter orientation based on, for example, agravity sensor or accelerometer.

In an embodiment, the docking station 106 of the hub 100 includes amechanical latch 118, or mechanically releasable catch to ensure thatmovement of the hub 100 doesn't mechanically detach the monitor 102 in amanner that could damage the same.

Although disclosed with reference to particular portable patientmonitors 102, an artisan will recognize from the disclosure herein alarge number and wide variety of medical devices that may advantageouslydock with the hub 100. Moreover, the docking station 106 mayadvantageously electrically and not mechanically connect with themonitor 102, and/or wirelessly communicate with the same.

FIG. 2 illustrates a simplified block diagram of an exemplary monitoringenvironment 200 including the hub 100 of FIG. 1 , according to anembodiment of the disclosure. As shown in FIG. 2 , the environment mayinclude the portable patient monitor 102 communicating with one or morepatient sensors 202, such as, for example, oximetry optical sensors,acoustic sensors, blood pressure sensors, respiration sensors or thelike. In an embodiment, additional sensors, such as, for example, a NIBPsensor or system 211 and a temperature sensor or sensor system 213 maycommunicate directly with the hub 100. The sensors 202, 211 and 213 whenin use are typically in proximity to the patient being monitored if notactually attached to the patient at a measurement site.

As disclosed, the portable patient monitor 102 communicates with the hub100, in an embodiment, through the docking station 106 when docked and,in an embodiment, wirelessly when undocked, however, such undockedcommunication is not required. The hub 100 communicates with one or moremulti-patient monitoring servers 204 or server systems, such as, forexample, those disclosed with in U.S. Pat. Pub. Nos. 2011/0105854,2011/0169644, and 2007/0180140. In general, the server 204 communicateswith caregiver backend systems 206 such as EMR and/or ADT systems. Theserver 204 may advantageously obtain through push, pull or combinationtechnologies patient information entered at patient admission, such asdemographical information, billing information, and the like. The hub100 accesses this information to seamlessly associate the monitoredpatient with the caregiver backend systems 206. Communication betweenthe server 204 and the monitoring hub 100 may be any recognizable to anartisan from the disclosure herein, including wireless, wired, overmobile or other computing networks, or the like.

FIG. 2 also shows the hub 100 communicating through its serial dataports 210 and channel data ports 212. As disclosed in the forgoing, theserial data ports 210 may provide data from a wide variety of patientmedical devices, including electronic patient bed systems 214, infusionpump systems 216 including closed loop control systems, ventilatorsystems 218, blood pressure or other vital sign measurement systems 220,or the like. Similarly, the channel data ports 212 may provide data froma wide variety of patient medical devices, including any of theforegoing, and other medical devices. For example, the channel dataports 212 may receive data from depth of consciousness monitors 222,such as those commercially available from SEDLine, brain or other organoximeter devices 224, noninvasive blood pressure or acoustic devices226, or the like. In an embodiment, channel device may includeboard-in-cable (“BIC”) solutions where the processing algorithms and thesignal processing devices that accomplish those algorithms are mountedto a board housed in a cable or cable connector, which in someembodiments has no additional display technologies. The BIC solutionoutputs its measured parameter data to the channel port 212 to bedisplayed on the display 104 of hub 100. In an embodiment, the hub 100may advantageously be entirely or partially formed as a BIC solutionthat communicates with other systems, such as, for example, tablets,smartphones, or other computing systems.

Although disclosed with reference to a single docking station 106, theenvironment 200 may include stacked docking stations where a subsequentdocking station mechanically and electrically docks to a first dockingstation to change the form factor for a different portable patentmonitor as discussed with reference to FIG. 5 . Such stacking mayinclude more than 2 docking stations, may reduce or increase the formfact for mechanical compliance with mating mechanical structures on aportable device.

FIG. 3 illustrates a simplified exemplary hardware block diagram of thehub 100 of FIG. 1 , according to an embodiment of the disclosure. Asshown in FIG. 3 , the housing 108 of the hub 100 positions and/orencompasses an instrument board 302, the display 104, memory 304, andthe various communication connections, including the serial ports 210,the channel ports 212, Ethernet ports 305, nurse call port 306, othercommunication ports 308 including standard USB or the like, and thedocking station interface 310. The instrument board 302 comprises one ormore substrates including communication interconnects, wiring, ports andthe like to enable the communications and functions described herein,including inter-board communications. A core board 312 includes the mainparameter, signal, and other processor(s) and memory, a portable monitorboard (“RIB”) 314 includes patient electrical isolation for the monitor102 and one or more processors, a channel board (“MID”) 316 controls thecommunication with the channel ports 212 including optional patientelectrical isolation and power supply 318, and a radio board 320includes components configured for wireless communications.Additionally, the instrument board 302 may advantageously include one ormore processors and controllers, busses, all manner of communicationconnectivity and electronics, memory, memory readers including EPROMreaders, and other electronics recognizable to an artisan from thedisclosure herein. Each board comprises substrates for positioning andsupport, interconnect for communications, electronic componentsincluding controllers, logic devices, hardware/software combinations andthe like to accomplish the tasks designated above and others.

An artisan will recognize from the disclosure herein that the instrumentboard 302 may comprise a large number of electronic components organizedin a large number of ways. Using different boards such as thosedisclosed above advantageously provides organization andcompartmentalization to the complex system.

Embodiments of Touch Screen Controls Including Certain Gestures

FIG. 4 illustrates a legend of finger control gestures 400 for use witha touchscreen display 104 according to an embodiment. The finger controlgestures 400 include a touch 402, a touch and hold 404, a touch and move406, a flick 408, a drag and drop 410, and a pinch 412. A touch 402 is afinger control gesture that executes the desired action once the user'sfinger is released from the screen. A touch and hold 404 is a fingercontrol gesture that executes the desired action once the user has heldhis or her finger on the screen continuously for a predeterminedduration (e.g., a few seconds), received a “hold completion”notification, and has released his or her finger from the screen. Atouch and move 406 is a finger control gesture that manipulates and/ortranslates objects across the display 104 in the desired and permitteddirection to a deliberate stopping point. To execute a touch and movefinger control gesture 406, the user touches an object, moves the object(left, right, up, down, diagonally, etc.), and releases the object. Aflick 408 is a finger control gesture comprising contact of an object onthe display 104 in conjunction with a quick finger movement in aparticular direction, typically along a single vector. To execute aflick 408 finger control gesture the user touches an object on thedisplay 104, moves the object (typically, but not necessarily in asingle direction) and releases the finger from the display 104 quickly,in a manner such that the contact point has a velocity throughout itspath of motion. A drag and drop 410 is a finger control gesture by whichthe user moves an object to another location or to another object (e.g.,a folder) and positions it there by releasing it. To execute a drag anddrop 410 finger control gesture, the user touches, holds, drags anddrops the object. A pinch 412 is a finger control gesture that expandsor contracts the field of view on the display 104. To execute a pinch412 finger control gesture, the user touches the display 104 at twotouch points using two fingers, for example, the thumb and index fingerof a user's hand. Moving the touch points apart from each other zooms inon the field of view, enlarging it, while moving the touch pointstogether zooms out on the field of view, contracting it.

In an embodiment the user interface includes multiple controls. Forexample, a toggle control enables a user to slide a knob to switchbetween toggle states. The toggle control also enables the user to pressleft or right of the toggle to quickly move the toggle left or right. Ifthe toggle control is labeled, the user can press the label to quicklymove the knob left or right.

The following paragraphs include a description of additional touchscreen controls that can be used with the system of the presentdisclosure. The system can include any combination of the followingcontrols and the present disclosure is not intended to be limited by thefollowing descriptions of various controls.

In some embodiments, a spinner control enables the user to press acenter (focused) tile to expand a spinner when the spinner is closed andto collapse a spinner when the spinner is opened. The spinner controlenables the user to swipe up or down which, when the spinner is open,scrolls through spinner tiles. The spinner control enables the user topress an unfocused tile which then scrolls the tile into a center,focused position. And the spinner control enables the user to collapsean open spinner by pressing anywhere outside the spinner.

A slider control enables the user to move a knob by sliding the knob.The slider control also enables the user to quickly move the knob to aspecific position by pressing anywhere along the slider path.

A slider spinner control combines the control capabilities of thespinner control and the slider control.

A button control enables a user to perform an action, as defined by thebutton description, by pressing the button.

An icon menu control enables the user to open a specified menu bypressing a tile. The icon menu control enables the user to scroll iconsleft or right by swiping left or right anywhere on the display. The iconmenu control enables the user to quickly center a tile corresponding toan indicator icon by pressing an indicator button.

A window control enables the user to open a parameter or measurementwindow when no parameter or measurement alarm is present, by pressingthe parameter or measurement. The window control enables the user tosilence a parameter or measurement alarm when a parameter or measurementalarm is present, by pressing the parameter or measurement. The windowcontrol enables a parameter or measurement to be moved to a differentlocation on the display 104 by using a drag and drop 410 finger controlgesture.

A well control enables the user to open a parameter or measurement menuwhen no parameter or measurement alarm is present, by pressing theparameter or measurement. The well control enables the user to silence aparameter or measurement alarm when a parameter or measurement alarm ispresent, by pressing the parameter or measurement.

A live waveform control enables the user to separate waveforms byswiping down. The live waveform control enables the user to combinewaveforms by swiping up.

A trend line control enables the user to zoom in by pinching in, zoomout by pinching out, change a time range by panning, and open aparameter or measurement trend menu by pressing the y-axis.

An alarm silence icon control enables the user to silence all alarms bypressing the alarm silence icon.

An audio pause icon control enables the user to pause audio for apredetermined period of time, by pressing the audio pause icon.

Other status bar icon controls enable the user to open the relevantmenu, by pressing the relevant status bar icon.

A back arrow control enables the user to exit a menu or abandon anychanges made, by pressing a back arrow icon.

A confirm-or-cancel control enables the user to confirm changes tosettings by pressing an OK button. The confirm-or-cancel control enablesthe user to cancel changes to settings by pressing a cancel button.

A home control enables the user to navigate to the main screen at anytime by pressing a home button.

Embodiments of Configurable Replay Display

FIG. 5 illustrates an embodiment of a user interface 500 displayed onthe display 104 of the hub 100. In an embodiment the display 104comprises a color, modular, touchscreen integral to the hub 100.Positioned horizontally along the top of the display 104 is a top statusline 501 that displays system status as well as that provides shortcutsto menu items or actions. In an embodiment the icons presented on thetop status line 501 include alarm silence 501A, audio pause 501B,profiles 501C, Bluetooth 501D, Wi-Fi 501E, Ethernet 501F, connectivitygateway 501G, portable patient monitor battery status 501H, monitoringhub battery status 501I, sounds 501J, and current time 501K.

The alarm silence icon 501A displays alarm status and mutes all audiblealarms for monitoring devices connected to the hub 100. The audio pauseicon 501B displays audio pause status and temporarily silences an alarmevent. The profiles icon 501C provides access to a profiles screen; theexample shown illustrates that the profile is set to “Adult” for anadult patient. The Bluetooth icon 501D provides access to a Bluetoothscreen. If this icon is visible on the status line 501, then Bluetoothconnectivity has been enabled. The Wi-Fi icon 501E provides access to aWi-Fi screen. If this icon is visible on the status line 501, then Wi-Ficonnectivity has been enabled. The icon itself also indicates thestrength of the wireless signal. The Ethernet icon 501F provides accessto an Ethernet screen. If this icon is visible on the status line 501,then Ethernet connectivity has been enabled.

The connectivity gateway icon 501G provides access to a connectivitygateway screen. The example illustrated indicates that standalonedevices are connected to three of the available four ports. The color ofthe icon matches the status colors of the connected standalone devices.The portable patient monitor battery status icon 501H displays thecharging status of the portable patient monitor 102 and provides accessto a portable patient monitor battery screen. The example illustratesthat the battery is currently charging. The monitoring hub batterystatus icon 501I displays the charging status of the monitoring hub 100and provides access to a monitoring hub battery screen. The exampleillustrates that the battery is currently charging. The sounds icon 501Jprovides access to a sounds screen to adjust alarm and pulse tonevolume. In an embodiment the sounds icon 501J does not indicate theactual volume level of the alarm and the pulse tone. The current timeicon 501K displays the current time and provides access to alocalization screen which contains settings related to local time,language and geography.

Positioned horizontally along the bottom of the display 104 is a bottomstatus line 502 that displays additional icons and information includinga main menu icon, a gender icon, and a patient identifier that includespatient-specific information, such as, for example, the patient's nameand room location. Although the disclosed embodiment employs statuslines 501, 502 oriented horizontally along the top and bottom of thedisplay 104, one skilled in the art would readily appreciate thatinformation of the type presented in the top status line 501 and in thebottom status line 502 may be presented in numerous different formats,combinations and configurations, including without limitation, one ormore status bars positioned vertically on the display 104. Moreover askilled artisan will appreciate that other useful information may bedisplayed in status bars 501, 502.

In an embodiment the user interface can create a window for everymonitoring device connected to the hub 100. Parameters or measurementscan be expanded within a window to customize views. A central portion504 of the display 104 presents patient measurement data, in thisexample, in two windows 506, 530. Illustratively, by way of non-limitingexample, an upper window 506 presents patient data measured by an anoninvasive monitoring platform, such as the Rainbow® Pulse CO-Oximetry™monitoring platform by Masimo Corporation of Irvine, Calif., whichenables the assessment of multiple blood constituents and physiologicparameters including oxygen saturation (SpO₂) 508, pulse rate (PR) 510,respiration rate (RRp) 512, fractional arterial oxygen saturation(SpfO₂) 514, total hemoglobin (SpHb) 516, plethysmograph variabilityindex (PVI) 518, methemoglobin (SpMet) 520, carboxyhemoglobin (SpCO)522, perfusion index (PI) 524, oxygen content (SpOC) 526, or others. Inthe illustrated example, the lower window 530 of the display 104presents patient data measured by a regional oximetry platform, such asthe O₃™ regional oximetry module by Masimo Corporation of Irvine,Calif., which allows the continuous assessment of tissue oxygenationbeneath one or more sensors placed on the patient's skin to helpclinicians detect regional hypoxemia.

Advantageously, the display 104 is configurable to permit the user toadjust the manner by which the physiologic parameters are presented onthe display 104. In particular, physiologic measurements of greaterinterest or importance to the clinician may be displayed in largerformat and may also be displayed in both numerical and graphical formatsto convey the current measurement as well as the historical trend ofmeasurements for a period of time, such as, for example, the precedinghour. In an embodiment the oxygen saturation 508, pulse rate 510, andrespiration rate 512 measurements are displayed in such a manner, takingup a larger portion of the upper portion 506 of the display 104, whilethe fractional arterial oxygen saturation 514, total hemoglobin 516,plethysmograph variability index 518, methemoglobin 520,carboxyhemoglobin 522, perfusion index 524, and oxygen content 526measurements are displayed as numbers, taking up a smaller portion ofthe upper portion 506 of the display 104.

In an embodiment the presentation of measurement information may beadjusted easily by using the finger control gestures 400. For example,the touch and move 406 finger control gesture may be used to move anobject on the display 104 representing a measurement from one locationof the display 104 to another location of the display 104.Advantageously, when the object is moved, the display 104 automaticallyscales its presentation of information based upon the parameters thatare active. For example, fewer parameters result in the presentation oflarger digits, trend lines, and waveform cycles. In an embodiment thelocation to which an object is moved determines, at least in part, themanner by which that object will be presented on the display 104.

Attention is now directed to a plurality of analysis presentation viewsthat may be presented on the disclosed monitoring hub 100.Advantageously, the disclosed monitoring hub 100 provides manyanalytical formats by which measured physiological parameters, as wellas other data, can be displayed to the user. Size, format, color, andlocation on the display, among other things, can be easily set andmodified by the clinician-user to readily customize the manner by whichmonitored physiological parameter data, as well as information derivedtherefrom, can be displayed.

FIG. 6A is an illustration of an exemplary display screen 600 showingvarious formats of analytical presentation views for illustratingreceived physiological parameter data, according to an embodiment of thedisclosure. The exemplary display screen 600 includes heat mapanalytical presentation views 602, box-and-whisker analyticalpresentation views 604, an index analytical presentation view 606,distribution analytical presentation views 608, histogram analyticalpresentation views 610, and gauge-histogram analytical presentationviews 612. The positions of each analytical presentation view may beadjusted and the format of each analytical presentation view may besubstituted with other formats, advantageously resulting in a highdegree of customization for the user. For example, the gauge-histogrampresentation views 612 are situated vertically in a right side panelportion of the screen 600, but may instead be situated in any formationand in any position on the screen 600.

Heat Maps

A heat map 602 analytical presentation view provides a two-dimensionalgraphical representation of a relationship between two measuredparameters over a specified period of time, using color to identifyareas in the graph where the data is concentrated. For example, asillustrated in FIG. 6B, the heat map 602 presents the relationshipbetween measured oxygen saturation (SpO2) and pulse rate (PR) atspecific points in time. Illustratively, by way of non-limiting example,an area on the graph corresponding to the highest concentration ofcorrelated values between measured oxygen saturation and pulse rate iscolored in a first color (e.g., red). FIG. 6B shows the heat mapcentered around an SpO2 value of about 98% and a PR value of about 61bpm. Moreover, FIG. 6B shows that as the concentration of correlatedmeasurements decreases, the colors on the heat map change (e.g., fromred to orange, then to yellow, then to green, and finally to blue)indicating progressively lower concentrations of correlated valuesbetween the two measured parameters.

Heat maps 602 advantageously provide a trend of multiple monitoredvalues or physiological parameters at a mere glimpse. For example, FIG.6B shows a caregiver that while the PR for the patient may be a littlelow, depending on age, fitness, activity level during monitoring, or thelike, the patient was almost if not entirely fully saturated withoxygen. Thus, because the body appears to be oxygenated, additional PRmay not be needed during the time period presented. Accordingly andadvantageously, the heat map 602 delivers a visual summary of the datathat enables the user to intuitively understand and analyze complexrelationships between data sets.

Box-And-Whisker Plots

In descriptive statistics, a box plot or boxplot is a convenient way ofgraphically depicting groups of numerical data through their quartiles.Box plots may also have lines extending vertically from the boxes(whiskers) indicating variability outside the upper and lower quartiles,these are often called box-and-whisker plots or diagrams. The spacingsbetween the different parts of the box indicate the degree of dispersion(spread) and skewness in the data, and show outliers.

As shown in FIG. 6C, a box-and-whisker plot analytical presentation view604 visually presents the range of measurements received over aspecified or pre-determined period of time, and the boundaries of thequartiles in which the data lies. Advantageously, the box-and-whiskerview 604 readily presents to the user the degree of spread, ordispersion, of the measured data, as well as the skewness in the data,including outlier measurements. The whiskers 620 and 622 identify thelow end and high end, respectively, of the range of measurementsdisplayed.

By way of illustrative example, as depicted in FIG. 6C, the range ofmeasured SpO2 data for a given patient may extend from 82% to 100%. Anartisan will recognize other patient's may have many other ranges. Thebox 624 identifies the median line 626 of the measured SpO2 parameterdata. Thus, half of the measured SpO2 data represented by the view 604falls above the median line 626 and half of the measured SpO2 data fallsbelow the median. The lower edge 628 and the upper edge 630 of the box624 identify the medians of the lower and upper half of the measuredSpO2 data, respectively. Thus, as illustrated in FIG. 6C, a firstquartile of measured SpO2 data lies between the end point of the bottomwhisker 620 and the bottom edge 628 of the box 624; a second quartile ofmeasured SpO2 data lies between the bottom edge 628 of the box 624 andthe median line 626; a third quartile of measured SpO2 data lies betweenthe median line 626 and the top edge 630 of the box 624; and a fourthquartile of measured SpO2 data lies between the top edge 630 of the box624 and the end point of the top whisker 622.

Again, box-and-whisper plots 604 advantageously provide a trend of amonitored value or physiological parameter at a mere glimpse. Forexample, FIG. 6C shows a caregiver that while SpO2 varied somewhat, atleast half the time it was above about 94% and a quarter of themonitored window SpO2 was between about 94% and about 98%. While abouthalf of the time, SpO2 was lower than perhaps desired.

Index Views

An index analytical presentation view 606, such as the continuous,noninvasive measurement of arterial hemoglobin concentration, which mayalso be referred to as a “total hemoglobin” (SpHb) index 606,exemplarily illustrated in FIG. 6D, presents a current measured state ofa physiological parameter (SpHb, in this example) relative to rangesidentified as acceptable, cautionary, and emergent. As illustrated inFIG. 6D, an indicator 632 shows a current measured parameter levelrelative to a vertical bar 634. The vertical bar 634 is shaded indifferent colors, such as, for example, green, yellow and red. Thecolors can be used to identify different regions or zones correspondingto, for example, acceptable, cautionary, and emergent values of themeasured parameter. A threshold line 636 can be set to visually identifyone zone from another. Illustratively, by way of non-limiting example,the threshold line 636 can identify the boundary between the range ofacceptable values and the range of cautionary values of the measuredparameter. In an embodiment, the user can set the ranges and boundaryconditions for such ranges. In other embodiments, the ranges andboundary conditions for a given physiological parameter are set todefault values corresponding to generally clinically accepted values forsuch ranges. The units of the measured parameter can be presented in awell 638 at the bottom of the index analytical presentation view 606.For example, as illustrated in FIG. 6D, the units of the physiologicalparameter being measured (total hemoglobin, SpHb) are in grams perdeciliter (g/dL) at a confidence interval (C.I.) of ninety percent.Advantageously, the index analytical display provides to the user aneasily-interpreted presentation of the measured physiological parameter.

Distribution Views

A distribution analytical presentation view 608, such as the SpO2distribution display 608 illustrated in FIG. 6E, presents a statisticaldistribution of a set of physiological parameter measurements over aspecified or pre-defined period of time. The distribution analyticalpresentation view 608 provides the user a visual representation of therange of physiological parameter measurements collected as well as astatistical distribution associated with such measurements.Illustratively, by way of non-limiting example, the distributionanalytical presentation view 608 shown in FIG. 6E presents adistribution 640 of the oxygen saturation (SpO2) parameter measurementsover a period of time. In the example depicted in FIG. 6E, thedistribution 640 is substantially normal (or Gaussian) with its mean (orexpected value) 642 illustrated as well. A current measured valueindicator 644 informs the user of the present state of the patient, anda standard deviation indicator 646 indicates the degree to which themeasured data varies or disperses over the range of values. A well 648toward the bottom of the distribution analytical display 608 providesnumerical units of the measured physiological parameter, such aspercentage for the oxygen saturation measurement.

Histogram Views

A histogram analytical presentation view 610, as illustrated in FIG. 6F,provides another graphical representation of a collection of measuredphysiological parameter data. A histogram represents an estimate of thestatistical (or probability) distribution of a continuous variable, suchas a continuously measured physiological parameter. Thus, rather thanproviding a statistical distribution (i.e., a probabilistic model) thatbest fits or corresponds to the measured data, the histogram reflectsthe actual measured data collected. To form a histogram, the entirerange of values to be measured is divided into a series of oftenequally-spaced, often consecutive, often non-overlapping intervals,referred to as “bins.” Each physiological parameter measurement value isthen allocated to one of the bins. A bar is drawn for each bin, wherethe height of the bar corresponds to the number of discretephysiological parameter measurements that fall within that bin'sparticular range. In an embodiment, the width of each bar is constant,corresponding to the ranges of the equally-spaced intervals. Thehistogram may also be normalized to display the relative frequency orproportion of measurements that fall into each of the several bins.Advantageously, the histogram analytical presentation view 610 providesthe user a visual representation of the actual frequencies of theobserved physiological parameter measurements in certain ranges ofvalues.

Analog Gages Including Histogram Views

A gauge-histogram analytical presentation view 612, as illustrated inFIG. 6G, provides a combination of analog, digital and histogram displayindicia in one presentational format view. Advantageously, thegauge-histogram analytical presentation view 612 provides to the user asubstantial amount of information related to the measured physiologicalparameter in an intuitive and visually accessible format. Thegauge-histogram 612 includes an analog indicator forming, for example, asemi-circular arc 650. Portions of the arc 650 can be differentiated byuse of various colors or shading to indicate different regions ofmeasured parameter values, such as, for example, acceptable, cautionaryand emergent regions of the gauge. Illustratively, by way ofnon-limiting example, the acceptable range of values can be coloredgreen, and can be located generally centrally within the arc 650, whilecautionary ranges of values can be colored yellow and located beyond theacceptable range of values, and emergent ranges of values can be coloredred and located beyond the cautionary value ranges toward the two endsof the arc 650. Of course, one skilled in the art will appreciate thatmany other colors and range formats may be used without departing fromthe scope of the present disclosure.

The gauge-histogram analytical presentation view 612 can include a dialmarker 652 that moves about the arc 650 reflecting the current measuredlevel of the monitored physiological parameter. Illustratively, by wayof non-limiting example, as the measured physiological parameter levelincreases, the dial can move clockwise, and as the measuredphysiological parameter level decreases, the dial can movecounter-clockwise, or vice versa. In this way, a user can quicklydetermine the patient's status by looking at the analog indicator. Forexample, if the dial marker 652 is in the center of the arc 650, theobserver can be assured that the current physiological parametermeasurement falls within the acceptable range. If the dial marker 652 isskewed too far to the left or right, the observer can quickly assess theseverity of the physiological parameter level and take appropriateaction. In other embodiments, acceptable parameter measurements can beindicated when the dial marker 652 is to the right or left, etc.

In some embodiments, the dial marker 652 can be implemented as a dot, adash, an arrow, or the like, and the arc 650 can be implemented as acircle, a spiral, a pyramid, or any other shape, as desired.Furthermore, the entire arc 650 can be illuminated or only portions ofthe arc 650 can be illuminated, based for example, on the currentphysiological parameter being measured. Additionally, the arc 650 canturn colors or be highlighted based on the current measuredphysiological parameter level. For example, as the dial marker 652approaches a threshold level, the arc 650 and/or the dial marker 652 canturn from green, to yellow, to red, shine brighter, flash, be enlarged,move to the center of the display, sound an alarm, or the like.

Different physiological parameters can have different thresholdsindicating abnormal conditions. For example, some physiologicalparameters may have upper and lower threshold levels, while otherphysiological parameters may only have an upper threshold or a lowerthreshold level. Accordingly, each gauge-histogram analyticalpresentation view 612 can be adjusted based on the particularphysiological parameter being monitored. Illustratively, by way ofnon-limiting example, an SpO2 gauge-histogram presentation view 612 canhave a lower threshold, which when met, activates an alarm, while arespiration rate gauge-histogram presentation view 612 can have both alower and an upper threshold, and when either threshold is met, an alarmcan be activated. The thresholds for each physiological parameter can bebased on typical, expected thresholds, or they can be set touser-specified threshold levels.

In certain embodiments, such as the embodiment illustrated in FIG. 6G,the gauge-histogram analytical presentation view 612 includes a digitalindicator 654. The analog arc 650 and digital indicator 654 can bepositioned in any number of formations relative to each other, such asside-by-side, above, below, transposed, etc. In the illustratedembodiment, the analog arc 650 is positioned above the digital indicator654. As described above, the analog arc 650 and dial marker 652 mayinclude colored warning sections, indicating a current position on thegraph. The digital information designates quantitative information fromthe graph. In FIG. 6G, for example, the gauge-histogram analyticalpresentation view 612 displays pulse rate information. The arc 650 showsthat from about 50 to about 140 beats per minute, the measured pulserate physiological parameter is either in the acceptable range orbeginning to enter the cautionary range, whereas in the regions outsidethose numbers, the arc 650 is colored to indicate an emergent or severecondition. Thus, as the dial marker 652 moves along the arc, 650, acaregiver can readily see where in the ranges of acceptable, cautionary,and emergent pulse rate values the current measurement falls. Thedigital indicator 654 provides a numerical representation of the currentmeasured value of the physiological parameter being displayed. Thedigital indicator 654 may indicate an actual measured value or anormalized value, and it can also be used to quickly asses the severityof a patient's condition.

As illustrated in FIG. 6G, a histogram arc 656 is located above andsurrounding the arc 650, having multiple radially-extending lines thatcorrespond to histogram bins (as described above with respect to FIG.6F) for the measured physiological parameter. The bins of the histogramarc 656 can be illuminated to reflect the distribution of measuredparameter values in the manner described above with respect to thehistogram analytical presentation view 610. In the embodimentillustrated in FIG. 6G, the bins are illuminated in colors correspondingto the ranges along the arc 650 in which they fall. Thus, the disclosedgauge-histogram analytical presentation view 612 provides analog anddigital indicia of the current measured physiological parameter,correlated with range information indicative of the level of urgencyrequired for the measured parameter, as well as a visual display of theactual distribution of the patient's parameter measurements over aperiod of time.

Advantageously, the hub 100 stores the measured data that it haspresented on the display screen 600 over time. In certain embodiments,the data is stored in the memory 304 of the instrument board 302. Incertain embodiments, the stored externally and accessed by themonitoring hub 100 via a network connection, such as, for example, anEthernet connection. In still other embodiments, the data is stored inboth on-board memory 304 and external storage devices.

Drag and Drop

Referring back to FIG. 6A, each of the foregoing display elements 6B,6C, 6D, 6E, 6F and 6G can be dragged onto the screen and dropped tocreate a customized view to match a caregiver's preferences for aparticular monitored patient. In an embodiment, a display element andits particular displayed parameters are shown as icons along a bottomhorizontally scrollable menu. When a caregiver wishes to place, forexample, a Perfusion Variability Index (PVI) distribution view on thescreen, he or she could select the PVI distribution icon from the bottomwell, scroll, and drag it to the screen to, for example, replace anyexisting display element. In another embodiment, a caregiver may selecta display element and then select the parameter or parameters to beprovided to the element.

Replay

FIG. 6A also shows the display screen 600 provides a replay feature,which permits the clinician to review a historical record of the patientdata collected and processed by the monitor 100. A user may select atime frame 662 for a replay period. For example, a user may selectbetween replaying a previous ten-minute period, a four-hour period, oran eight-hour period. Any amount of time may be a suitable replayperiod. In an embodiment, the screen 600 may provide a default timeframe 662, for example eight hours. After a replay period is selected ora default period is determined, a user may select a replay icon 660 tobegin replay.

In certain embodiments, the stored data may be replayed on differentmonitor hubs or on different displays (such as, for example, a displayconnected to a multi-patient monitoring server 204), to permitclinicians who are remote from the patient's care environment to accessand review the monitored data.

During a replay period, stored data may be displayed on the screen 600at different rates. For example, the replayed data can be displayed atthe same rate of time in which the data was originally presented. Thus,replaying one hour of recorded data would take one hour to fully replay.Alternatively, the replayed data can be displayed in slow-motion (slowerthan real-time), or in a time-lapse (faster than real-time) formats. Forexample, to replay in slow-motion, the screen 600 may present each frameof data for a longer period of time than originally presented.Illustratively, by way of non-limiting example, slow-motion replay canbe useful to review and analyze portions of the recorded physiologicalparameter data in which abrupt changes occur. Time-lapse replay permitsthe clinician to review a period of recorded data over a shorter periodof time than the data was originally presented. In an embodiment, toreplay in time-lapse mode, a screen 600 may accelerate a speed at whichframes are displayed. In another embodiment, to replay in time-lapsemode, a screen 600 may display only a sampling of frames from a set ofdata. For example, a screen 600 may display every fifteenth frame sothat data may be presented in a shorter time while still providing auseful illustration of the stored data. In an embodiment, the user canselect the rate at which the time-lapse replay will progress. Forexample, by way of illustration, the user might choose to view oneminute's worth of real-time data in one second or in ten seconds. Thisinformation may be particularly useful to a care provider who would liketo quickly review a patient's physiological conditions from a previoustime period when, for example, the care provider was not present toobserve the data as it was originally presented.

In certain embodiments, multiple parameter displays presented on thescreen 600 may synchronously replay stored data during a replay period,while other parameter displays may present live data. This allows theclinician to concurrently monitor the present condition of the patientand review (i.e., replay) past measurement data. Illustratively, by wayof non-limiting example, a series of analytical displays in a centerportion of the screen 600 may replay stored data, while a series ofgauge-histogram analytical displays 612, located in a side panel, maypresent live data. In another embodiment, every feature on the screen600 may replay stored data during a replay period. FIG. 7 illustratessuch an example, and the display 700 provides a message 702 indicatingthat the displayed data is being replayed. In yet another embodiment,any single analytical display or combination of analytical displays onthe screen 600 may present live data during a replay period. In someembodiments, individual analytical displays may have individual icons orindicators (not shown) associated with them to indicate whether theanalytical presentation view is presenting live or stored and replayeddata. In some embodiments, an individual display element may includeboth replayed and live data.

FIG. 8 is a flowchart illustrating a replay process 800 according to anembodiment of the present disclosure. At optional block 802, a userconfigures the display 600 with the display elements a caregiver desiresfor the monitored patient. The drag and drop functionality allows theuser to straightforwardly drag the display elements to the portion ofthe screen desired. In an embodiment, a default screen layout could beimplemented. Alternatively or additionally, the screen may be set to themost recent replay configuration, a replay configuration matched to aknown user, known caregiver, or the patient, or some or all of theforegoing.

In optional block 804, the user sets a time period for replay. Asdiscussed above, any amount of time may be a suitable time period. Forexample, a user may choose between a two-hour, four-hour, eight-hour, orten-minute replay period. In an embodiment, a user may select atimeframe icon 662 to set the time period. In other embodiments, theuser can scroll backward on a timeline (not shown) to select a startingpoint and ending point for the replay. In other embodiments, the usercan input a start time and end time for the replay.

At optional block 806, the user may select a replay interval whichdefines the rate at which the replay displays. In certain embodiments,the replay interval includes real-time, slow-motion, and time-lapseintervals. Illustratively, a replay interval may be indicative of thenumber of frames of stored data which are displayed when selecting atime-lapse mode of replay. For example, a user may choose to have everyfifteenth frame or every tenth frame of recorded data to be displayed inorder to shorten the time required to replay stored data. In otherembodiments, the user may be presented a timeline the width of theoptionally selected time period and the user may pinch the timelinebigger or smaller to automatically adjust the interval.

At block 808, time is set to the start of the time period. At block 810,measurement data is accessed. In an embodiment, a processor accessesonly the data used in the active display elements; in other embodiments,all the data associated with a particular time is accessed. In anembodiment, the processor synchronizes data to the display time eventhough such data may not be from the same measurement device. In otherembodiments, synchronization data may be stored along with the originalmeasurement data for use when accessed during the replay process 800.

At block 812, the data is displayed to the user through the configureddisplay elements. At optional block 814, a user may interrupt replay topause, speed up or slow down the replay, zoom in or out on a timeperiod, switch to another time period, end replay, change displayelements, or otherwise manipulate the data being replayed. In optionalblock 816, such interrupts are handled and appropriate action is taken,such as, for example, restarting replay with new configuration or timeparameters.

At block 818, the process 800 determines if playback has reached the endof the selected playback time period. If so, the process 800 ends; ifnot, the display rate is added to the current display time and theprocess 800 returns to block 810 to access additional data.

Advantageously, process 800 allows a caregiver to straightforwardlymonitor a wide variety of measurements and combinations of measurementsfor a particular time period. For example, the caregiver may see duringreplay a heat map 602 fluctuate in color and/or position, pulse orotherwise show how the body of the patient is oxygenated and what pulserate it is using for such oxygenation. Likewise, box-and-whisker plots604 may have portions that grow, shrink, and move in rhythm with, forexample, the heat map 602. Distributions 608 may change and histogramsalong with their analog gages may provide indications of how the body isreacting over a course of pre-selected time.

As discussed above, a user may run a replay process by selecting areplay icon 660. Once the replay process is complete, a user may choosewhether to repeat the process, at block 808. If the user chooses torepeat the process, the process 800 will again run at step 806. If theuser chooses not to repeat the process, the process will end at block810.

Thus, a patient monitoring hub that serves as the center of patientmonitoring and treatment activities for a given patient is disclosed.Embodiments of the patient monitoring hub include a large visual displaythat dynamically provides information to a caregiver about a widevariety of physiological measurements or otherwise-determinedparameters. Advantageously, the display can be customized by theclinician-user to present the desired physiological parameters (andother relevant information) in the formats and at the locations on thedisplay that the clinician desires. Numerous analytical presentationviews are provided to present the monitored physiological parameters(and other information) in visual formats that provide timely,clinically-relevant, and actionable information to the care provider.Additionally, the disclosed monitoring hub allows for replay of all orportions of the monitored data in a synchronized manner. The embodimentsdisclosed herein are presented by way of examples only and not to limitthe scope of the claims that follow. One of ordinary skill in the artwill appreciate from the disclosure herein that many variations andmodifications can be realized without departing from the scope of thepresent disclosure.

The term “and/or” herein has its broadest least limiting meaning whichis the disclosure includes A alone, B alone, both A and B together, or Aor B alternatively, but does not require both A and B or require one ofA or one of B. As used herein, the phrase “at least one of” A, B, “and”C should be construed to mean a logical A or B or C, using anon-exclusive logical or.

The term “plethysmograph” includes it ordinary broad meaning known inthe art which includes data responsive to changes in volume within anorgan or whole body (usually resulting from fluctuations in the amountof blood or air it contains).

The following description is merely illustrative in nature and is in noway intended to limit the disclosure, its application, or uses. Forpurposes of clarity, the same reference numbers will be used in thedrawings to identify similar elements. It should be understood thatsteps within a method may be executed in different order withoutaltering the principles of the present disclosure.

As used herein, the term module may refer to, be part of, or include anApplication Specific Integrated Circuit (ASIC); an electronic circuit; acombinational logic circuit; a field programmable gate array (FPGA); aprocessor (shared, dedicated, or group) that executes code; othersuitable components that provide the described functionality; or acombination of some or all of the above, such as in a system-on-chip.The term module may include memory (shared, dedicated, or group) thatstores code executed by the processor.

The term code, as used above, may include software, firmware, and/ormicrocode, and may refer to programs, routines, functions, classes,and/or objects. The term shared, as used above, means that some or allcode from multiple modules may be executed using a single (shared)processor. In addition, some or all code from multiple modules may bestored by a single (shared) memory. The term group, as used above, meansthat some or all code from a single module may be executed using a groupof processors. In addition, some or all code from a single module may bestored using a group of memories.

The apparatuses and methods described herein may be implemented by oneor more computer programs executed by one or more processors. Thecomputer programs include processor-executable instructions that arestored on a non-transitory tangible computer readable medium. Thecomputer programs may also include stored data. Non-limiting examples ofthe non-transitory tangible computer readable medium are nonvolatilememory, magnetic storage, and optical storage. Although the foregoinginvention has been described in terms of certain preferred embodiments,other embodiments will be apparent to those of ordinary skill in the artfrom the disclosure herein. Additionally, other combinations, omissions,substitutions and modifications will be apparent to the skilled artisanin view of the disclosure herein. Accordingly, the present invention isnot intended to be limited by the reaction of the preferred embodiments,but is to be defined by reference to claims.

Additionally, all publications, patents, and patent applicationsmentioned in this specification are herein incorporated by reference tothe same extent as if each individual publication, patent, or patentapplication was specifically and individually indicated to beincorporated by reference.

What is claimed is:
 1. A portable device configured to displayphysiological parameters of a user, the device comprising: an electronicprocessor configured to be in wireless communication with one or morephysiological sensors worn on a body part of the user, wherein the oneor more physiological sensors comprise a pulse oximetry sensor, theelectronic processor further configured to receive values of at leastsome of the physiological parameters measured by the one or morephysiological sensors; and a touchscreen display, wherein, responsive toa first input from the user, the touchscreen display is configured todisplay received values of the physiological parameters by visuallypresenting a range of historical oxygen saturation values, received overa first time interval in a vertical bar, the first input comprising theuser's selection of a timeframe icon and the first time interval beingbased on the user's selection of the timeframe icon, wherein a height ofthe vertical bar indicates a degree of spread of data measured by thepulse oximetry sensor, a top and bottom of the vertical bar indicatingrespectively a high end and a low end of the historical oxygensaturation values, and wherein in response to a second input from theuser, the touchscreen display is configured to automatically adjust thevertical bar to visually present a different range of historical oxygensaturation values received over a second time interval different fromthe first time interval.
 2. The device of claim 1, wherein theelectronic processor is further configured to be in wirelesscommunication with one or more medical devices to receive data of otherones of the physiological parameters measured by the one or more medicaldevices.
 3. The device of claim 2, wherein the one or more medicaldevices are made by at least two different manufacturers.
 4. The deviceof claim 1, wherein the touchscreen display is further configured todisplay the received values of the physiological parameters in one ormore of numerical, graphical, waveform, or trend lines.
 5. The device ofclaim 1, wherein the touchscreen display is further configured todisplay respiratory rate values by visually presenting a range of therespiratory rate values received over a specified or pre-determinedperiod of time in a vertical bar.
 6. The device of claim 1, wherein theoxygen saturation values are continuously measured oxygen saturationvalues.
 7. The device of claim 1, wherein the electronic processor isconfigured to add encryption to the received physiological parametermeasurements.
 8. The device of claim 1, wherein the electronic processoris configured to communicates with a caregiver's data management systemto advantageously associate the received values of the physiologicalparameters with the user on the data management system.
 9. The device ofclaim 8, wherein the electronic processor is configured to pass thereceived values of the physiological parameter to the data managementsystem without the caregiver associating each physiological sensor withthe patient.
 10. A portable device configured to display physiologicalparameters of a user, the device comprising: an electronic processorconfigured to be in wireless communication with one or morephysiological sensors worn on a body part of the user, wherein the oneor more physiological sensors comprise a pulse oximetry sensor, theelectronic processor further configured to receive values of at leastsome of the physiological parameters measured by the one or morephysiological sensors; and a touchscreen display, wherein, responsive toa first input from the user, the touchscreen display is configured todisplay the received values of the physiological parameters by visuallypresenting a range of historical values of one of the physiologicalparameters received over a first time interval in a vertical bar, thefirst input comprising the user's selection of a timeframe icon and thefirst time interval being based on the user's selection of the timeframeicon, wherein a height of the vertical bar indicates a degree of spreadof measured data of the one of the physiological parameters, a top andbottom of the vertical bar indicating respectively a high end and a lowend of the historical values of the one of the physiological parametersreceived, and wherein in response to a second input from the user, thetouchscreen display is configured to automatically adjust the verticalbar to visually present a different range of historical values of theone of the physiological parameters received over a second time intervaldifferent from the first time interval.
 11. The device of claim 10,wherein the electronic processor is further configured to be in wirelesscommunication with one or more medical devices to receive data of otherones of the physiological parameters measured by the one or more medicaldevices.
 12. The device of claim 11, wherein the one or more medicaldevices are made by at least two different manufacturers.
 13. The deviceof claim 10, wherein the touchscreen display is further configured todisplay the received values of the physiological parameters in one ormore of numerical, graphical, waveform, or trend lines.
 14. The deviceof claim 10, wherein the one of the physiological parameters is heartrate or oxygen saturation.
 15. The device of claim 10, wherein the oneof the physiological parameters respiratory rate.
 16. The device ofclaim 10, wherein the electronic processor is configured to addencryption to the received physiological parameter measurements.
 17. Thedevice of claim 10, wherein the electronic processor is configured tocommunicates with a caregiver's data management system to advantageouslyassociate the received values of the physiological parameters with theuser on the data management system.
 18. The device of claim 17, whereinthe electronic processor is configured to pass the received values ofthe physiological parameters to the data management system without thecaregiver associating each physiological sensor with the patient.